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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of workers' compensation insurance and |
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group accident and health insurance together in a packaged plan. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 10, Insurance Code, is amended |
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by adding Chapter 2056 to read as follows: |
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CHAPTER 2056. PACKAGED PLAN OF WORKERS' COMPENSATION AND ACCIDENT |
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AND HEALTH INSURANCE |
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Sec. 2056.001. DEFINITIONS. In this chapter: |
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(1) "Compensable injury" has the meaning assigned by |
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Section 401.011, Labor Code. |
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(2) "Packaged plan" means a plan offering a workers' |
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compensation policy together with a group accident and health |
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insurance policy as described in Section 2056.002. |
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(3) "Workers' compensation insurance company" means a |
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stock company, mutual insurance company, reciprocal or |
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interinsurance exchange, or Lloyd's plan authorized to engage in |
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the business of workers' compensation insurance in this state. |
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Sec. 2056.002. CONTRACT WITH ACCIDENT AND HEALTH INSURANCE |
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COMPANY TO PROVIDE PACKAGED PLAN. (a) A workers' compensation |
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insurance company may contract with an accident and health |
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insurance company to offer to employers a workers' compensation |
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insurance policy and a group accident and health insurance policy |
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together in one packaged plan under which employees and their |
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dependents are eligible for major medical expense coverage and |
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employees are covered for medical benefits and other benefits |
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required by Chapter 408, Labor Code. |
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(b) Nothing in this chapter authorizes a workers' |
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compensation insurance company to underwrite group accident and |
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health insurance policies. A group accident and health insurance |
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policy offered by a workers' compensation insurance company must be |
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provided by an entity that is authorized to write group accident and |
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health insurance and is separate from the workers' compensation |
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insurance company. |
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Sec. 2056.003. PROVISION OF MEDICAL BENEFITS THROUGH HEALTH |
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INSURANCE. (a) Subject to this section, a workers' compensation |
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insurance company that offers a packaged plan may allow for medical |
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benefits required under Chapter 408, Labor Code, to be provided to |
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employees through the group accident and health insurance policy in |
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the packaged plan. |
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(b) A packaged plan must require that benefits related to a |
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compensable injury other than medical benefits be provided |
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exclusively through the workers' compensation insurance policy in |
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the packaged plan. Medical benefits for a compensable injury |
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provided through a group accident and health insurance policy under |
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Subsection (a) continue to be governed by Title 5, Labor Code, and |
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Chapter 1305 of this code. |
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(c) A packaged plan offered under this section may not |
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impose cost-sharing requirements for workers' compensation medical |
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benefits that are covered under the group accident and health |
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insurance policy in a packaged plan. |
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(d) To the extent employees contribute to the premiums for |
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group accident and health coverage provided under a packaged plan |
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offered under this section, those contributions must exclude any |
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portion of the premiums allocated to the provision of workers' |
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compensation medical benefits under this section. |
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(e) A packaged plan offered under this section must provide |
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that medical examinations required under Subchapter A, Chapter 408, |
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Labor Code, are covered exclusively under the workers' compensation |
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insurance policy included in the packaged plan. |
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Sec. 2056.004. WORKERS' COMPENSATION OBLIGATIONS AFTER |
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INSOLVENCY OR TERMINATION. (a) A workers' compensation insurance |
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company that offers a packaged plan that allows for workers' |
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compensation medical benefits to be provided through the group |
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accident and health insurance policy in the packaged plan continues |
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to be liable for those workers' compensation obligations provided |
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through the group accident and health insurance policy if the |
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company issuing the group accident and health insurance policy |
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becomes insolvent or if the group accident and health coverage |
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terminates. |
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(b) Nothing in this chapter may be construed to relieve a |
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workers' compensation insurance company from any obligation to |
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provide benefits required by Chapter 408, Labor Code. |
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(c) Nothing in this chapter relieves the Texas Property and |
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Casualty Insurance Guaranty Association of any obligations with |
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respect to a workers' compensation insurance company offering a |
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packaged plan under this chapter. |
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Sec. 2056.005. EXCLUSIVE REMEDY NOT AFFECTED. Nothing in |
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this chapter affects the exclusivity, as provided by Section |
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408.001, Labor Code, of the remedy of recovery of workers' |
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compensation benefits for an employee covered by a packaged plan or |
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a legal beneficiary against the employer or an agent or employee of |
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the employer for the death of or a work-related injury sustained by |
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the employee. |
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Sec. 2056.006. CERTAIN CLAIMS AGAINST WORKERS' |
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COMPENSATION CLAIMANT PROHIBITED. (a) As provided by Section |
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413.042, Labor Code, a health care provider may not pursue a private |
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claim against a workers' compensation claimant covered by a |
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packaged plan for all or part of the cost of a health care service |
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provided by the provider except as provided by that section. |
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(b) A health care provider commits an administrative |
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violation under Title 5, Labor Code, if the provider violates |
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Subsection (a). |
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Sec. 2056.007. RULES. The commissioner shall adopt rules |
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as necessary to implement this chapter, including rules relating |
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to: |
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(1) establishing additional solvency requirements for |
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an insurance company offering a workers' compensation insurance |
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policy or group accident and health insurance policy under this |
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chapter; and |
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(2) modifying any disclosures otherwise required by |
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statute regarding accident and health policies that are not |
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workers' compensation when the disclosures are provided in |
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connection with a packaged plan. |
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SECTION 2. This Act takes effect September 1, 2023. |